Med Wars: Rheumy vs. PCP
I'm quite newly diagnosed, and wondering how to balance the relationship between my primary care provider (like him) and my rheumatologist(love him!).
I had a really bed experience with my last family doc. I gave him way too many chances to tell me I was crazy. So about a month ago, I switched to a new fella. He cares a lot, and spends excellent amounts of time with me. He lets me ask questions and really listens. But I went to see him today, and told him about my Rheumy putting me on Plaquenil and a tapering dose of Prednisone. He hates that I'm on steroids, and he really wants me off of them. He suggested that instead of tapering by the week, as my rheumy prescribed, I knock the doses down every 3 days. He also said, "You know, Plaquenil really weakens your immune system." I wanted to scream, "THAT'S THE WHOLE POINT! SO IT STOPS TRYING TO KILL ME!"
My main problem right now is the question of who to obey. I'm afraid, since the Rheumy is my hero, and he's telling me all the things I've been longing to hear for a year, that I'm ignoring valid points from the PCP. On the other hand, the PCP obviously doesn't have a lot of experience with patients with autoimmune diseases.
Have any of you had this problem? Any suggestions on how to mesh these two very different docs into one treatment plan would be much appreciated. Thanks!
It sounds like you have a good rheumo (they are hard to find), and that you trust his judgement. Although many PCP's do cross somewhat into rheumo territory, and can be very helpful that way, I think in this case you should stick with the rheumo's orders and meds. Rheumotologists are technically the specialist who will diagnose and treat most autoimmune disorders, including Lupus. And, it sounds a bit like your PCP doesn't quite have a handle on the subject of immunosupressant drugs and their effect on patients with autoimmune disorders.
You could maybe tell the PCP that you appreciate his concern for you, and his cautious attitude about the meds you are on, and that you will not forget his warnings, but for now, you are going to stay with the plan the rheumo has you on. Anyway, that's just my opinion. Let's see what some of the others here think.
I have to agree with Rob on this one. Few of us get lucky enough to find a great Rhuemy and it sounds like you have one. The PC is correct in the fact that steroids are not good for us but the Rhuemy is correct that often times we need that. You said it PERFECTLY with your comment about needing it to weaken your immune system (it actually made me LOL). Since it appears that you have a really good specialist I would listen to him. Sounds like he has a handle on this and that is what you want. If the GP doesn't like it then go get another. Those are a dime a dozen! As long as you have one good one on your side you have a leg up on many here.
Definitely stick with your Rheumy's recomendations.
I have been on Prednisolone for 40 years and my Rheumy has put my on Methotrexate so I can reduce the Pred levels I'm on 10mg and he has me reducing it by 1/2 a mg a month (Know this sounds very drawn out but I've had mobility problems when I tried reducing before)Wants dose down to 7mgs.
I have to agree with Rob and Mari a good Rheumy is worth their weight in gold, GPs are generally not as well informed on Lupus
what else can i say, ...............................................
listen to the wise ones..
Ditto what Rob said
Ditto what Tgal said
Ditto what Merrylin said
Ditto Steve's saying "What else can I say?"
From your own knowledge of Prednisone and its use for Lupus, and from the knowledge of your rheumatologist....you have made the right decision about remaining of the dosage prescribed by your rheumy.
You should also know (and consider) that, for many, tapering too quickly on the Prednisone actually can cause some symptoms to re-appear and/ for them to worsen and for new symptoms to crop up. So the slower the taper, the better!
I wish you the very best
Peace and Blessings
The rheumy is a specialist in a particular field. Your pcp is a "jack of all trades" which is good for generalities but he's not an expert on the subject of Lupus nor is he supposed to be that's why he's a pcp and not a rheumy. So listen to the rheumy. However, if it is a battle of the egos, suggest a time and place, have them duke it out, sell tickets and raise money for charity! Just a twisted thought...
And of course, if all of these ideas fail, a light saber duel to the death is always entertaining. When in doubt, let their knowledge of The Force determine their destiny...
LOL Rob! You always make me chuckle. Thanks for that
Originally Posted by rob
Ah, it's just my inner sci-fi geek rearing it's ugly head.
Originally Posted by tgal